Symptoms – Persistent Cough

One of the most common symptoms of lung cancer is a persistent cough, with estimates ranging from 47% to 86% of lung cancer patients experiencing cough.1 While some people don’t experience any symptoms in the earliest stages of lung cancer, others do experience symptoms before diagnosis. Some people with lung cancer also experience coughing that produces blood or rust-colored sputum (spit or phlegm).2

In healthy individuals, coughing is a protective mechanism that expels chemical irritants and foreign bodies out of the airways. These foreign substances provoke coughing by stimulating receptors in the airways. In lung cancer, coughing can occur by the tumor tissue stimulating these receptors, or by the inflammatory response of the body, which stimulates the nerves in the airways. In addition, lung cancer can cause pleural effusion, a build-up of fluid in the chest cavity. Pleural effusion can also cause a cough. Treatment-induced cough can also occur as a result of radiation therapy. Patients with lung cancer can also experience coughing due to non-cancer related causes.1

Assessing coughing in lung cancer

A thorough assessment is critical to identifying the cause of coughing, as each patient may have different underlying contributing factors. The assessment should include:

The type of cough (whether it produces sputum or not)

Trigger factors (things that cause the cough)

When the cough is experienced (day, night or both)

The effects of coughing on the patient’s quality of life

All medications the patient is taking

Frequency of coughing

Severity of coughing

The presence of other conditions (comorbidities), such as chronic obstructive pulmonary disease (COPD) or asthma

Any changes in coughing since the diagnosis of cancer1

Managing coughing in lung cancer

Having a persistent cough can be distressing, and symptoms such as cough become more prevalent as lung cancer becomes more advanced. Palliative care is a specialized field that aims to alleviate symptoms and maximize the patient’s quality of life. Palliative care does not focus on curing the disease or prolonging life, which is the goal of other cancer treatments, such as chemotherapy. However, palliative care is an important part of the patient’s treatment plan and encompasses physical symptoms, psychosocial distress, spiritual distress, and caregiver distress.3

The first goal of treating coughing is to address any underlying causes that are reversible, such as treating asthma or COPD. Some of the drugs used to treat other conditions may also help in treating cough in lung cancer. Potential treatments include oral corticosteroids, bronchodilators (such as albuterol), or antibiotics when an infection is present.1

Chemotherapy can improve symptoms in lung cancer, and several studies have shown chemotherapy can improve coughing. Radiation therapy targeted to the tumors in the lungs has also shown to help control coughing. Additional medications that can be used to alleviate coughing include opioid medications (like morphine) or drugs that have a local anesthetic (numbing) effect (like lidocaine).1

Other symptoms of lung cancer

While coughing is one of the most common symptoms in lung cancer, others include: